ALSO in Palestine
By Dina Nasser
The complications of pregnancy and childbirth are the leading cause of death and disability among women of reproductive age in developing countries. It is estimated that around 515,000 women die each year from maternal causes. And for every woman who dies, approximately 30 more suffer injuries, infection and disabilities in pregnancy or childbirth. Many of these deaths are preventable in settings where women have access to trained birth attendants, particularly providers capable of managing the obstetric emergencies that develop in up to 10% of all deliveries, often unexpectedly, regardless of whether delivery occurs in a medical setting such as a hospital or maternity home, at home or, in the case of Palestine, at a checkpoint, on the road, or in another inappropriate setting.
The presence of a trained birth attendant is essential at every delivery. It is estimated that only 55% of world total births are attended by trained personnel. The availability of service providers with adequate skills in emergency obstetrics and neonatal resuscitation is not only important for situations where access to a health facility is limited but also everywhere women deliver including maternity homes and hospital maternity wards. In Palestine, where political and military conflicts have limited client and provider access to health care facilities and to each other, and have disrupted referrals from primary care units to hospitals equipped for more complex emergencies, it is essential that health providers with emergency obstetric and neonatal care skills be widely available and accessible. To ensure the sustainability of such services, it is also essential that instructors be trained and available for both basic training and for up-dates for providers who have been trained in the past.
The Juzoor Foundation for Health and Social Development has strived over the past few years to provide continuous medical education programmes that are within international standards and in turn respond to national needs and indicators. One such programme is the Advanced Life Support in Obstetrics (ALSO) methodology for addressing obstetric emergencies combined with Neonatal Resuscitation (NNR). These two courses have been helping to improve the outcomes of complicated deliveries around the world for more than a decade. They contribute to the standardization and quality of obstetric care, promoting quality care as a basic health right; introducing new, evidence-based approaches to medicine in the region, and empowering midwives by improving their performance.
The ALSO programme is owned and managed by the American Academy of Family Physicians since 1993. The programme has facilitated the training and certification of thousands of health providers including gynaecologists /obstetricians, physicians, residents, nurses, nurse midwives and other health professionals. In addition, ALSO-certified individuals are trained as instructors, advisory faculty and course directors to sustain the training programme and facilitate expansion throughout the world of a cadre of certified health personnel able to provide high quality interventions in response to obstetric emergencies.
In 2002 Juzoor obtained the exclusive license for ALSO in Palestine, and the only other experience in the Arab world at that time was in the United Arab Emirates. Juzoor has among its staff the only faculty advisor in the region and participates in the international ALSO advisory board meetings annually.
The ALSO courses are under continual evidence-based review and the curriculum has been updated and revised a number of times to a) reflect changes that are evidence based relative to emergency life-saving procedures and protocols, and b) respond effectively to the evolving training/skills needs of maternity care providers. ALSO Provider Courses are approved for continuing medical education (CME) credit and have been recommended for inclusion in medical, midwifery and nursing school curricula.
The course includes a variety of teaching methodologies including skill stations, didactic lectures, hands-on small group workshops and skill stations and testing stations.
ALSO in Palestine and the region
In order to institutionalize continuous medical education effectively Juzoor has, through a memorandum of understanding, cooperated systematically with the National Paediatrics Association and the Gynaecologists /Obstetricians Certification Board in the implementation of these two programmes. A national faculty of ALSO instructors has been established, and they are continuously involved in the programme implementation, evaluation and participation in national and international meetings related to ALSO. The programme has been so successful nationally that Juzoor took the initiative to introduce the ALSO methodology to the region, completing a training programme at the end of 2005 in Amman in cooperation with the University of Jordan and with participation from other Arab countries including Jordan, Palestine, Egypt, Yemen and Syria
Achievements to date
• 201 certified providers in Palestine (West Bank and Gaza)
• 30 ALSO providers from Arab countries
• 350 providers who have successfully passed the Neonatal Resuscitation course
• 32 national approved ALSO instructors
• 13 instructor candidates in the region
• One ALSO faculty advisor
• National Neonatal Resuscitation faculty
The ALSO programme has contributed nationally towards improved quality of Emergency Obstetric Care (EOC); facilitated the standardization of EOC; increased access to high quality EOC; enhanced teamwork between physicians and midwives; and
opened dialogue among OB/GYNs from different cities and enhanced relationships between OB/GYNs and the paediatricians who attend Neonatal Resuscitation training. The programme has been so successful that it has been recommended as a pre-requisite for OB/GYN board certification.
Such a model is being institutionalized by Juzoor and is the aim for the way forward in the various continuous education courses in the health sector in Palestine. The need to start accrediting courses nationally and incorporating a formal continuous education programme for health professionals will ascertain standards and quality of performance both at the continuous education level and in the performance on the ground.
Dina Nasser is a registered nurse with a Master’s in Pubic Health. She is the director of Juzoor “Foundation for Health and Social Development.”